Goal of ObamaCare

[CountryMed]

As I understand it, ObamaCare had 2 major goals which were decrease the cost of healthcare and decrease the amount of uninsured. Goal 1B has been for the most part successful , though healthcare cost seems to big the most important aspect hence the name ; Affordable Care Act. Through the first 3 years of the law, it was advertised to have slowed the rise in healthcare cost increase to around 6%. This doesn't seem to have translated to more "affordable" insurance for citizens though. A report on NPR announced today that premiums through the exchange will rise on average with double digit increases for the second year in a row.

I am not political and very much want our nation to find a solution to make healthcare for affordable, but as is well publicized this law does little to actually focus on cost cutting measures. We have come far with parts of the law such as movement towards preventative care , available birth control, and pre- existing illness clause, etc... For those who understand the law, what is missing that will actually address the same cost that the law was implemented to decrease?

As a middle class family the increase in premiums hurt, as coming from a family who owns a small to medium sized business (60 employees) it is devastating .

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[The Cheat]

No one can truly say what policy would control healthcare costs. There are many debates about what needs to be done with healthcare. The ACA has lowered the rate at which premiums increase in certain states but it may not be enough to control spiraling healthcare costs in the long run.

 

[DrMason]

The ACA has made so many people stop seeing doctors. With the high deductibles and STILL high premiums, this is the worst of two worlds. You are essentially paying the costs of a LOW-DEDUCTIBLE policy, but getting a HIGH-DEDUCTIBLE product.

Veterans are starting to go back tomVA even if they have private care for same reasons. It is a disaster. We need HSA, TRUE high-deductible policies and transparency.

 

[BackForrealz]

The ACA has made so many people stop seeing doctors. With the high deductibles and STILL high premiums, this is the worst of two worlds. You are essentially paying the costs of a LOW-DEDUCTIBLE policy, but getting a HIGH-DEDUCTIBLE product.

Veterans are starting to go back tomVA even if they have private care for same reasons. It is a disaster. We need HSA, TRUE high-deductible policies and transparency.

Tell me about it!

 

[DrMason]

I don't know much about politics in general, but Trumps talk about HSA and high-deductible accounts is probably the closest to a REAL attempt at fixing the broken system. Irrespectively of that, medical students will, for most continue to reject primary care. NP's and PA's cannot replace them, especially when the poor last PCP standing will have to cosign every chart and become the liability sponge.
http://medicaleconomics.modernmedic...iability-actions-midlevel-providers?page=full

MY last employer was forcing/compelling us to see and interact with mid-level clinical problems. This ended up becoming nothing but having to rubber stamp everything in an otherwise busy schedule and no compensation whatsoever. THEN, I happened to see a patient one of our NP's had seen the week before and it as just another "lesion" that could have been a melanoma, but we were not sure at this point. Patient was told to watch it until we got a derm referral (to dump the liability further on). At the bottom of the progress note, it said(Discussed with DrXXXX, which approved and agreed with treatment. I took another look at other patients, remember this is our group EMR, so no HIPPA breech there and YES< every single time I dropped my head in, the noted ended with same comment. I put my foot down and from there it was a "how dare you" attitude from the clinical director, who only sees patients two days a week and makes more than us (of course)..

Last week, I just heard from some old collegues that wanted me to teach them ICP and Botox. Of course, their group heard about it and said they could not.

Obamacare is not about care, but only about:

*Giving out more free stuff from Peter to Paul for votes.
*Breaking the backs of independent MD's and small practices.
*Destroy a political lobbying group, although the latter is not needed. Our political lobby groups will end up doing anything ANY president says, IMHO.
Also, since I don't see or hear about lots of "trench physicians" having much influence here, the people who do LESS patient care will tell the ones what to do, and how.
*Ensure physicians get further enmeshed and entrapped with no knowledge about their real market value.

VA at my local area (still in touch with a VA friend) are seeing an uptick in their patients despite everybody saying "they hate it". They have no choice as deductibles with Obamacare is an impossibility for most people of today.

On the direct practice seminars I went with my wife to, the objective market value of a PCP is above 400K. People out of residency are cheering if they get a contract with 200! With that comes "sign-on bonus" with plenty clauses; restrictive covenant, which really is an unconstitutional thing to begin with and the knowledge that as a "fresh" attending you are just as vulnerable to abuse, hazing and mistreatment as when you were an intern. And Obamacare wants to further destroy the incentive further to work for the system?

If this is something you think has at least elements of sense to it, I can only recommend reading "Atlas Shrugged" with Ayn Rand to see what is likely to happen. Let the "administrators", "clinic managers", "QI experts" and "risk reduction" experts see patients themselves. Have the ambulance chasers come and help out telling them what to do. I am sure there will be enough physicians left to pick up the slack, but many "supervisors" may have to start seeing patient again. Opooops, that wasn't part of the plan...

 

[DrMason]

No one can truly say what policy would control healthcare costs. There are many debates about what needs to be done with healthcare. The ACA has lowered the rate at which premiums increase in certain states but it may not be enough to control spiraling healthcare costs in the long run.

"Have reduced the premiums"?? This is directly wrong with what I observe. Patients tell me they cannot afford their deductibles while premiums have INCREASED. Yes, premiums for the takers may have dropped from ZERO to nothing, but for all the part-time work victims along with those too poor to have money and too rich to get anything free, this has reduced and destroyed their income and family economy. While this is of course not everywhere, blanket stating the premiums have dropped is at best a misestimate and at worst another lie..

The biggest problem with Obamacare, IMHO is that it is destroying the middle class as we speak. Continuing to ask them to pay for this show, while expecting people to work for free is just not going to work.

 

[GH253]

The purpose of ObamaCare is to crush what's left of the market system and make full socialism seem like the only alternative.